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Government Accountability Office Reviewing Nursing Home Rating System

Nursing home abuse and neglect is an ongoing serious problem across the United States. Everyday vulnerable senior citizens are being abused physically, emotionally, sexually, and financially. Families place their loved ones in these facilities believing that they will receive the care and respect they deserve. There is supposed to be meaningful oversight to prevent abuse. But the abuse happens anyway. Fortunately a government agency is finally taking a look at the way these facilities are rated to see if the system can be improved.

GAO is Reviewing the System

The Government Accountability Office (GAO) is responsible for the review according to a report by the Republican Herald. The decision comes after two senators and a congressperson sent a written request to the agency. The rating system in question is Medicare’s “Five-star Quality Rating” used by the “Nursing Home Compare Tool.” The lawmakers initially requested the review because of reports of incidents of misconduct occurring at well rated facilities.

What is the Five-Star Quality Rating System?

The Five Star Nursing Home Quality Rating System is a government rating of facility performance based on health inspections, quality measures, and hours of care provided per resident. The theory behind the rating system is that potential nursing home patients or their families should be able to use them as a tool in comparing nursing home options. It involves individual ratings for health inspection results, quality measures, and staffing. It also includes an overall rating. The overall rating system works as follows:

*First, the Centers for Medicare & Medicaid Services (CMS) obtains the health inspection rating for the nursing home.

*One star is added if the staffing rating is four or five stars and it is greater than the health inspections rating. If the staffing rating is only one star, then one star is subtracted.

*If the quality measures rating is only one star, then one star is subtracted from the overall rating. If the quality measures rating is five stars, a star is added to the overall rating.

*If the health inspections rating is one star then the overall rating can only be increased by one total star based on the staffing and quality measure ratings. In other words, a six-star rating is not possible.

*If a nursing home is a special focus facility then the maximum rating it can receive is three stars.

A History of Problems Have there Been With This System

There is not a lot of information available on the effectiveness of the current system because some changes in how the scores are calculated were put into effect this past February. Those changes came after The New York Times reported last year that the ratings system allowed nursing homes to manipulate their ratings. The main problem at that time was that the ratings were based primarily on self-reported data. While the changes to the system did result in many homes being downgraded, none of the major changes reported by CMS appear to change this problem, making the GAO’s review all that much more important.

See Related Posts:

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Revamped Rating System Downgrades Nearly One-Third of Homes